Friday, March 21, 2008

Fat, Carbs and the Science of Conception

This article makes a lot of sense, but I wouldn't recommend as much dairy as they do...


Fat, Carbs and the Science of Conception

In a groundbreaking new book, Harvard researchers look at the role of diet, exercise and weight control in fertility. Guarantee: you will be surprised.

Owen Franken / Corbis

Every new life starts with two seemingly simple events. First, an active sperm burrows into a perfectly mature egg. Then the resulting fertilized egg nestles into the specially prepared lining of the uterus and begins to grow. The key phrase in that description is "seemingly simple." Dozens of steps influenced by a cascade of carefully timed hormones are needed to make and mature eggs and sperm. Their union is both a mad dash and a complex dance, choreographed by hormones, physiology and environmental cues.

A constellation of other factors can come into play. Many couples delay having a baby until they are financially ready or have established themselves in their professions. Waiting, though, decreases the odds of conceiving and increases the chances of having a miscarriage. Fewer than 10 percent of women in their early 20s have issues with infertility, compared with nearly 30 percent of those in their early 40s. Sexually transmitted diseases such as chlamydia and gonorrhea, which are on the upswing, can cause or contribute to infertility. The linked epidemics of obesity and diabetes sweeping the country have reproductive repercussions. Environmental contaminants known as endocrine disruptors, such as some pesticides and emissions from burning plastics, appear to affect fertility in women and men. Stress and anxiety, both in general and about fertility, can also interfere with getting pregnant. Add all these to the complexity of conception and it's no wonder that infertility is a common problem, besetting an estimated 6 million American couples.

It's almost become a cliché that diet, exercise and lifestyle choices affect how long you'll live, the health of your heart, the odds you'll develop cancer and a host of other health-related issues. Is fertility on this list? The answer to that question has long been a qualified "maybe," based on old wives' tales, conventional wisdom—and almost no science. Farmers, ranchers and animal scientists know more about how nutrition affects fertility in cows, pigs and other commercially important animals than fertility experts know about how it affects reproduction in humans. There are small hints scattered across medical journals, but few systematic studies of this crucial connection in people.

It had a silver lining, though, and not just for those selling low-carb advice and products. All the attention made scientists and the rest of us more aware of carbohydrates and their role in a healthy diet. It spurred several solid head-to-head comparisons of low-carb and low-fat diets that have given us a better understanding of how carbohydrates affect weight and weight loss. The new work supports the growing realization that carbohydrate choices have a major impact—for better and for worse—on the risk for heart disease, stroke, type 2 diabetes and digestive health.

New research from the Nurses' Health Study shows that carbohydrate choices also influence fertility. Eating lots of easily digested carbohydrates (fast carbs), such as white bread, potatoes and sugared sodas, increases the odds that you'll find yourself struggling with ovulatory infertility. Choosing slowly digested carbohydrates that are rich in fiber can improve fertility. This lines up nicely with work showing that a diet rich in these slow carbs and fiber before pregnancy helps prevent gestational diabetes, a common and worrisome problem for pregnant women and their babies. What do carbohydrates have to do with ovulation and pregnancy?

More than any other nutrient, carbohydrates determine your blood-sugar and insulin levels. When these rise too high, as they do in millions of individuals with insulin resistance, they disrupt the finely tuned balance of hormones needed for reproduction. The ensuing hormonal changes throw ovulation off-kilter.

Knowing that diet can strongly influence blood sugar and insulin, we wondered if carbohydrate choices could influence fertility in average, relatively healthy women. The answer from the Nurses' Health Study was yes. We started by grouping the study participants from low daily carbohydrate intake to high. One of the first things we noticed was a connection between high carbohydrate intake and healthy lifestyles.

Women in the high-carb group, who got nearly 60 percent of their calories from carbs, ate less fat and animal protein, drank less alcohol and coffee, and consumed more plant protein and fiber than those in the low-carb group, who got 42 percent of calories from carbohydrates. Women in the top group also weighed less, weren't as likely to smoke and were more physically active. This is a good sign that carbohydrates can be just fine for health, especially if you choose good ones.

The total amount of carbohydrate in the diet wasn't connected with ovulatory infertility. Women in the low-carb and high-carb groups were equally likely to have had fertility problems. That wasn't a complete surprise. As we described earlier, different carbohydrate sources can have different effects on blood sugar, insulin and long-term health.

We set out to change this critical information gap with the help of more than 18,000 women taking part in the Nurses' Health Study, a long-term research project looking at the effects of diet and other factors on the development of chronic conditions such as heart disease, cancer and other diseases. Each of these women said she was trying to have a baby. Over eight years of follow-up, most of them did. About one in six women, though, had some trouble getting pregnant, including hundreds who experienced ovulatory infertility—a problem related to the maturation or release of a mature egg each month. When we compared their diets, exercise habits and other lifestyle choices with those of women who readily got pregnant, several key differences emerged. We have translated these differences into fertility-boosting strategies.

At least for now, these recommendations are aimed at preventing and reversing ovulatory infertility, which accounts for one quarter or more of all cases of infertility. They won't work for infertility due to physical impediments like blocked fallopian tubes. They may work for other types of infertility, but we don't yet have enough data to explore connections between nutrition and infertility due to other causes. And since the Nurses' Health Study doesn't include information on the participants' partners, we weren't able to explore how nutrition affects male infertility. From what we have gleaned from the limited research in this area, some of our strategies might improve fertility in men, too. The plan described in The Fertility Diet doesn't guarantee a pregnancy any more than do in vitro fertilization or other forms of assisted reproduction. But it's virtually free, available to everyone, has no side effects, sets the stage for a healthy pregnancy, and forms the foundation of a healthy eating strategy for motherhood and beyond. That's a winning combination no matter how you look at it.

Slow Carbs, Not No Carbs
Once upon a time, and not that long ago, carbohydrates were the go-to gang for taste, comfort, convenience and energy. Bread, pasta, rice, potatoes—these were the highly recommended, base-of-the-food-pyramid foods that supplied us with half or more of our calories. Then in rumbled the Atkins and South Beach diets. In a scene out of George Orwell's "1984," good became bad almost overnight as the two weight-loss juggernauts turned carbohydrates into dietary demons, vilifying them as the source of big bellies and jiggling thighs. Following the no-carb gospel, millions of Americans spurned carbohydrates in hopes of shedding pounds. Then, like all diet fads great and small, the no-carb craze lost its luster and faded from prominence.


Evaluating total carbohydrate intake can hide some important differences. So we looked at something called the glycemic load. This relatively new measure conveys information about both the amount of carbohydrate in the diet and how quickly it is turned to blood sugar. The more fast carbs in the diet, the higher the glycemic load. (For more on glycemic load, go to health.harvard.edu/newsweek.) Women in the highest glycemic-load category were 92 percent more likely to have had ovulatory infertility than women in the lowest category, after accounting for age, smoking, how much animal and vegetable protein they ate, and other factors that can also influence fertility. In other words, eating a lot of easily digested carbohydrates increases the odds of ovulatory infertility, while eating more slow carbs decreases the odds.

Because the participants of the Nurses' Health Study complete reports every few years detailing their average daily diets, we were able to see if certain foods contributed to ovulatory infertility more than others. In general, cold breakfast cereals, white rice and potatoes were linked with a higher risk of ovulatory infertility. Slow carbs, such as brown rice, pasta and dark bread, were linked with greater success getting pregnant.

Computer models of the nurses' diets were also revealing. We electronically replaced different nutrients with carbohydrates. Most of these substitutions didn't make a difference. One, though, did. Adding more carbohydrates at the expense of naturally occurring fats predicted a decrease in fertility. This could very well mean that natural fats, especially unsaturated fats, improve ovulation when they replace easily digested carbohydrates.

In a nutshell, results from the Nurses' Health Study indicate that the amount of carbohydrates in the diet doesn't affect fertility, but the quality of those carbohydrates does. Eating a lot of rapidly digested carbohydrates that continually boost your blood-sugar and insulin levels higher can lower your chances of getting pregnant. This is especially true if you are eating carbohydrates in place of healthful unsaturated fats. On the other hand, eating whole grains, beans, vegetables and whole fruits—all of which are good sources of slowly digested carbohydrates—can improve ovulation and your chances of getting pregnant.

Balancing Fats
In 2003, the government of Denmark made a bold decision that is helping protect its citizens from heart disease: it essentially banned trans fats in fast food, baked goods and other commercially prepared foods. That move may have an unexpected effect—more little Danes. Exciting findings from the Nurses' Health Study indicate that trans fats are a powerful deterrent to ovulation and conception. Eating less of this artificial fat can improve fertility, and simultaneously adding in healthful unsaturated fats whenever possible can boost it even further.

Women, their midwives and doctors, and fertility researchers have known for ages that body fat and energy stores affect reproduction. Women who don't have enough stored energy to sustain a pregnancy often have trouble ovulating or stop menstruating altogether. Women who have too much stored energy often have difficulty conceiving for other reasons, many of which affect ovulation. These include insensitivity to the hormone insulin, an excess of male sex hormones and overproduction of leptin, a hormone that helps the body keep tabs on body fat.

A related issue is whether dietary fats influence ovulation and reproduction. We were shocked to discover that this was largely uncharted territory. Until now, only a few studies have explored this connection. They focused mainly on the relationship between fat intake and characteristics of the menstrual cycle, such as cycle length and the duration of different phases of the cycle. In general, these studies suggest that more fat in the diet, and in some cases more saturated fat, improves the menstrual cycle. Most of these studies were very small and didn't account for total calories, physical activity or other factors that also influence reproduction. None of them examined the effect of dietary fat on fertility.

The dearth of research in this area has been a gaping hole in nutrition research. If there is a link between fats in the diet and reproduction, then simple changes in food choices could offer delicious, easy and inexpensive ways to improve fertility. The Nurses' Health Study research team looked for connections between dietary fats and fertility from a number of different angles. Among the 18,555 women in the study, the total amount of fat in the diet wasn't connected with ovulatory infertility once weight, exercise, smoking and other factors that can influence reproduction had been accounted for. The same was true for cholesterol, saturated fat and monounsaturated fat—none were linked with fertility or infertility. A high intake of polyunsaturated fat appeared to provide some protection against ovulatory infertility in women who also had high intakes of iron, but the effect wasn't strong enough to be sure exactly what role this healthy fat plays in fertility and infertility.

Trans fats were a different story. Across the board, the more trans fat in the diet, the greater the likelihood of developing ovulatory infertility. We saw an effect even at daily trans fat intakes of about four grams a day. That's less than the amount the average American gets each day.

Eating more trans fat usually means eating less of another type of fat or carbohydrates. Computer models of the nurses' diet patterns indicated that eating a modest amount of trans fat (2 percent of calories) in place of other, more healthful nutrients like polyunsaturated fat, monounsaturated fat or carbohydrate would dramatically increase the risk of infertility. To put this into perspective, for someone who eats 2,000 calories a day, 2 percent of calories translates into about four grams of trans fat. That's the amount in two tablespoons of stick margarine, one medium order of fast-food french fries or one doughnut.

Fats aren't merely inert carriers of calories or building blocks for hormones or cellular machinery. They sometimes have powerful biological effects, such as turning genes on or off, revving up or calming inflammation and influencing cell function. Unsaturated fats do things to improve fertility—increase insulin sensitivity and cool inflammation—that are the opposite of what trans fats do. That is probably why the largest decline in fertility among the nurses was seen when trans fats were eaten instead of monounsaturated fats.

The Protein Factor
At the center of most dinner plates sits, to put it bluntly, a hunk of protein. Beef, chicken and pork are Americans' favorites, trailed by fish. Beans lag far, far behind. That's too bad. Beans are an excellent source of protein and other needed nutrients, like fiber and many minerals. And by promoting the lowly bean from side dish to center stage and becoming more inventive with protein-rich nuts, you might find yourself eating for two. Findings from the Nurses' Health Study indicate that getting more protein from plants and less from animals is another big step toward walking away from ovulatory infertility.

Scattered hints in the medical literature that protein in the diet may influence blood sugar, sensitivity to insulin and the production of insulin-like growth factor-1—all of which play important roles in ovulation—prompted us to look at protein's impact on ovulatory infertility in the Nurses' Health Study.

We grouped the participants by their average daily protein intake. The lowest-protein group took in an average of 77 grams a day; the highest, an average of 115 grams. After factoring in smoking, fat intake, weight and other things that can affect fertility, we found that women in the highest-protein group were 41 percent more likely to have reported problems with ovulatory infertility than women in the lowest-protein group.

When we looked at animal protein intake separately from plant protein, an interesting distinction appeared. Ovulatory infertility was 39 percent more likely in women with the highest intake of animal protein than in those with the lowest. The reverse was true for women with the highest intake of plant protein, who were substantially less likely to have had ovulatory infertility than women with the lowest plant protein intake.

That's the big picture. Computer models helped refine these relationships and put them in perspective. When total calories were kept constant, adding one serving a day of red meat, chicken or turkey predicted nearly a one-third increase in the risk of ovulatory infertility. And while adding one serving a day of fish or eggs didn't influence ovulatory infertility, adding one serving a day of beans, peas, tofu or soybeans, peanuts or other nuts predicted modest protection against ovulatory infertility.

Eating more of one thing means eating less of another, if you want to keep your weight stable. We modeled the effect that juggling the proportions of protein and carbohydrate would have on fertility. Adding animal protein instead of carbohydrate was related to a greater risk of ovulatory infertility. Swapping 25 grams of animal protein for 25 grams of carbohydrates upped the risk by nearly 20 percent. Adding plant protein instead of carbohydrates was related to a lower risk of ovulatory infertility. Swapping 25 grams of plant protein for 25 grams of carbohydrates shrank the risk by 43 percent. Adding plant protein instead of animal protein was even more effective. Replacing 25 grams of animal protein with 25 grams of plant protein was related to a 50 percent lower risk of ovulatory infertility.

These results point the way to another strategy for overcoming ovulatory infertility—eating more protein from plants and less from animals. They also add to the small but growing body of evidence that plant protein is somehow different from animal protein.

Milk and Ice Cream
Consider the classic sundae: a scoop of creamy vanilla ice cream crisscrossed by rivulets of chocolate sauce, sprinkled with walnuts and topped with a spritz of whipped cream. If you are having trouble getting pregnant, and ovulatory infertility is suspected, think of it as temporary health food. OK, maybe that's going a bit too far. But a fascinating finding from the Nurses' Health Study is that a daily serving or two of whole milk and foods made from whole milk—full-fat yogurt, cottage cheese, and, yes, even ice cream—seem to offer some protection against ovulatory infertility, while skim and low-fat milk do the opposite.

The results fly in the face of current standard nutrition advice. But they make sense when you consider what skim and low-fat milk do, and don't, contain. Removing fat from milk radically changes its balance of sex hormones in a way that could tip the scales against ovulation and conception. Proteins added to make skim and low-fat milk look and taste "creamier" push it even farther away.

It would be an overstatement to say that there is a handful of research into possible links between consumption of dairy products and fertility. The vanishingly small body of work in this area is interesting, to say the least, given our fondness for milk, ice cream and other dairy foods. The average American woman has about two servings of dairy products a day, short of the three servings a day the government's dietary guidelines would like her to have.

The depth and detail of the Nurses' Health Study database allowed us to see which foods had the biggest effects. The most potent fertility food from the dairy case was, by far, whole milk, followed by ice cream. Sherbet and frozen yogurt, followed by low-fat yogurt, topped the list as the biggest contributors to ovulatory infertility. The more low-fat dairy products in a woman's diet, the more likely she was to have had trouble getting pregnant. The more full-fat dairy products in a woman's diet, the less likely she was to have had problems getting pregnant.

Our advice on milk and dairy products might be criticized as breaking the rules. The "rules," though, aren't based on solid science and may even conflict with the evidence. And for solving the problem of ovulatory infertility, the rules may need tweaking. Think about switching to full-fat milk or dairy products as a temporary nutrition therapy designed to improve your chances of becoming pregnant. If your efforts pay off, or if you stop trying to have a baby, then you may want to rethink dairy—especially whole milk and other full-fat dairy foods—altogether. Over the long haul, eating a lot of these isn't great for your heart, your blood vessels or the rest of your body.

Before you sit down to a nightly carton of Häagen-Dazs ("The Fertility Diet said I needed ice cream, honey"), keep in mind that it doesn't take much in the way of full-fat dairy foods to measurably affect fertility. Among the women in the Nurses' Health Study, having just one serving a day of a full-fat dairy food, particularly milk, decreased the chances of having ovulatory infertility. The impact of ice cream was seen at two half-cup servings a week. If you eat ice cream at that rate, a pint should last about two weeks.

Equally important, you'll need to do some dietary readjusting to keep your calorie count and your waistline from expanding. Whole milk has nearly double the calories of skim milk. If you have been following the U.S. government's poorly-thought-out recommendation and are drinking three glasses of milk a day, trading skim milk for whole means an extra 189 calories a day. That could translate into a weight gain of 15 to 20 pounds over a year if you don't cut back somewhere else. Those extra pounds can edge aside any fertility benefits you might get from dairy foods. There's also the saturated fat to consider, an extra 13 grams in three glasses of whole milk compared with skim, which would put you close to the healthy daily limit.

Aim for one to two servings of dairy products a day, both of them full fat. This can be as easy as having your breakfast cereal with whole milk and a slice of cheese at lunch or a cup of whole-milk yogurt for lunch and a half-cup of ice cream for dessert. Easy targets for cutting back on calories and saturated fat are red and processed meats, along with foods made with fully or partially hydrogenated vegetable oils.

Once you become pregnant, or if you decide to stop trying, going back to low-fat dairy products makes sense as a way to keep a lid on your intake of saturated fat and calories. You could also try some of the nondairy strategies for getting calcium and protecting your bones. If you don't like milk or other dairy products, or they don't agree with your digestive system, don't force yourself to have them. There are many other things you can do to fight ovulatory infertility. This one is like dessert—enjoyable but optional.

The Role of Body Weight
Weighing too much or too little can interrupt normal menstrual cycles, throw off ovulation or stop it altogether. Excess weight lowers the odds that in vitro fertilization or other assisted reproductive technologies will succeed. It increases the chances of miscarriage, puts a mother at risk during pregnancy of developing high blood pressure (pre-eclampsia) or diabetes, and elevates her chances of needing a Cesarean section. The dangers of being overweight or underweight extend to a woman's baby as well.

Weight is one bit of information that the participants of the Nurses' Health Study report every other year. By linking this information with their accounts of pregnancy, birth, miscarriage and difficulty getting pregnant, we were able to see a strong connection between weight and fertility. Women with the lowest and highest Body Mass Indexes (BMI) were more likely to have had trouble with ovulatory infertility than women in the middle. Infertility was least common among women with BMIs of 20 to 24, with an ideal around 21.

Keep in mind that this is a statistical model of probabilities that links weight and fertility. It doesn't mean you'll get pregnant only if you have a BMI between 20 and 24. Women with higher and lower BMIs than this get pregnant all the time without delay or any medical help. But it supports the idea that weighing too much or too little for your frame can get in the way of having a baby.

We call the range of BMIs from 20 to 24 the fertility zone. It isn't magic—nothing is for fertility—but having a weight in that range seems to be best for getting pregnant. If you aren't in or near the zone, don't despair. Working to move your BMI in that direction by gaining or losing some weight is almost as good. Relatively small changes are often enough to have the desired effects of healthy ovulation and improved fertility. If you are too lean, gaining five or 10 pounds can sometimes be enough to restart ovulation and menstrual periods. If you are overweight, losing 5 percent to 10 percent of your current weight is often enough to improve ovulation.

Being at a healthy weight or aiming toward one is great for ovulatory function and your chances of getting pregnant. The "side effects" aren't so bad, either. Working to achieve a healthy weight can improve your sensitivity to insulin, your cholesterol, your blood pressure and your kidney function. It can give you more energy and make you look and feel better.

While dietary and lifestyle contributions to fertility and infertility in men have received short shrift, weight is one area in which there has been some research. A few small studies indicate that overweight men aren't as fertile as their healthy-weight counterparts. Excess weight can lower testosterone levels, throw off the ratio of testosterone to estrogen (men make some estrogen, just as women make some testosterone) and hinder the production of sperm cells that are good swimmers. A study published in 2006 of more than 2,000 American farmers and their wives showed that as BMI went up, fertility declined. In men, the connection between increasing weight and decreasing fertility can't yet be classified as rock solid. But it is good enough to warrant action, mainly because from a health perspective there aren't any downsides to losing weight if you are overweight. We can't define a fertility zone for weight in men, nor can anyone else. In lieu of that, we can say to men who are carrying too many pounds that shedding some could be good for fertility and will be good for overall health.

The Importance of Exercise
Baby, we were born to run. That isn't just the tagline of Bruce Springsteen's anthem to young love and leavin' town. It's also a perfect motto for getting pregnant and for living a long, healthy life. Inactivity deprives muscles of the constant push and pull they need to stay healthy. It also saps their ability to respond to insulin and to efficiently absorb blood sugar. When that leads to too much blood sugar and insulin in the bloodstream, it endangers ovulation, conception and pregnancy. Physical activity and exercise are recommended and even prescribed for almost everyone—except women who are having trouble getting pregnant. Forty-year-old findings that too much exercise can turn off menstruation and ovulation make some women shy away from exercise and nudge some doctors to recommend avoiding exercise altogether, at least temporarily. That's clearly the right approach for women who exercise hard for many hours a week and who are extremely lean. But taking it easy isn't likely to help women who aren't active or those whose weights are normal or above where they should be. In other words, the vast majority of women.

Some exciting results from the Nurses' Health Study and a handful of small studies show that exercise can be a boon for fertility. These important findings are establishing a vital link between activity and getting pregnant. Much as we would like to offer a single prescription for conception-boosting exercise, however, we can't. Some women need more exercise than others, for their weight or moods, and others are active just because they enjoy it. Some who need to be active aren't, while a small number of others may be too active.

Instead of focusing on an absolute number, try aiming for the fertility zone. This is a range of exercise that offers the biggest window of opportunity for fertility. Being in the fertility zone means you aren't overdoing or underdoing exercise. For most women, this means getting at least 30 minutes of exercise every day. But if you are carrying more pounds than is considered healthy for your frame (i.e., a BMI above 25), you may need to exercise for an hour or more. If you are quite lean (i.e., your BMI is 19 or below), aim for the middle of the exercise window for a few months. Keep in mind that the fertility zone is an ideal, not an absolute. Hospital delivery rooms are full of women who rarely, or never, exercise. Not everyone is so lucky. If you are having trouble getting pregnant, then maybe the zone is the right place for you.

Whether you classify yourself as a couch potato or an exercise aficionado, your fertility zone should include four types of activity: aerobic exercise, strength training, stretching and the activities of daily living. This quartet works together to control weight, guard against high blood sugar and insulin, and keep your muscles limber and strong. They are also natural stress relievers, something almost everyone coping with or worrying about infertility can use.

Exercise has gotten a bad rap when it comes to fertility. While the pioneering studies of Dr. Rose Frisch and her colleagues convincingly show that too much exercise coupled with too little stored energy can throw off or turn off ovulation in elite athletes, their work says nothing about the impact of usual exercise in normal-weight or overweight women. Common sense says that it can't be a big deterrent to conception. If it were, many of us wouldn't be here. Our ancestors worked hard to hunt, forage, clear fields and travel from place to place. Early Homo sapiens burned twice as many calories each day as the average American does today and were fertile despite it—or because of it.

Results from the Nurses' Health Study support this evolutionary perspective and show that exercise, particularly vigorous exercise, actually improves fertility. Exercising for at least 30 minutes on most days of the week is a great place to start. It doesn't really matter how you exercise, as long as you find something other than your true love that moves you and gets your heart beating faster.

Chavarro and Willett are in the Department of Nutrition at the Harvard School of Public Health. Skerrett is editor of the Harvard Heart Letter. For more information, go to health.harvard.edu/newsweek or thefertilitydiet.com .

© 2007

Mammograms: More Harm Than Good

Mammograms: More Harm than Good

From Alternative Medicine, October 2007

Breast Check: Do mandatory mammograms do more harm than good? By Vonalda M. Utterback, CN

"Time to make breast pancakes," says one friend of mine, referring to her scheduled mammography screening. And although she may crack jokes about the experience, she's never once questioned the need for her annual pilgrimage, nor has her physician discussed the risks versus the benefits it entails. After all, if you are a woman aged 40 or beyond, yearly mammograms are simply de rigueur.

When your doctor refers you for a screening, he or she is likely following the guidelines of the two leading national cancer research and information organizations primarily responsible for setting public health policy on cancer screening: The private American Cancer Society (ACS) and the government's National Cancer Institute (NCI). Both, along with other well-funded, high-profile organizations, such as Susan G. Komen for the Cure, recommend regular mammogram screening of symptom-free women beginning at age 40.

All this official blessing shouldn't make regular screening mammography sacrosanct, however. In fact, it's way past time for women to start asking hard questions about the exam's efficacy and its potential harm, say many women's health experts, advocates, and researchers. "Screening mammography is clearly a double-edged sword," explains Lisa Schwartz, MD, co-director of the Veteran's Administration Outcomes Group in White River Junction, Vermont, and associate professor of medicine at Dartmouth Medical School.

False truths
According to the National Academy of Sciences 2005 publication, Saving Women's Lives: Strategies for Improving breast cancer Detection and Diagnosis, the risk of a false-positive result in a mammogram is about 1 in 10. About three-quarters of the resulting biopsies turn out to be benign, it's true, but to learn that a woman has to endure the fear that she has breast cancer and bear the cost, discomfort, and risk of additional medical procedures.

"Regular screening will save some lives, but it will cause even more women to be harmed through the unnecessary diagnosis and treatment of cancer that would never have affected their health, were it not for screening," says Schwartz. She's referring to false-positives associated with "ductal carcinoma in situ" (DCIS), a result that many experts consider one of the most harmful risks associated with screening mammography.

DCIS is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. It is not cancer, but it may, in some cases, become invasive cancer and spread to other tissues. Because they can't predict which lesions will become invasive cancer and which will remain contained in the breast duct, doctors usually treat DCIS like cancer. "Most women with DCIS will be advised to undergo invasive treatment of unknown benefit, such as lumpectomy combined with radiation," reports Schwartz.
Harm from over-diagnosis of invasive cancer also may occur because many malignant cancers grow quite slowly, says Peter C. Gotzsche, MD, researcher and director of the Nordic Cochrane Centre in Copenhagen, Sweden. If cancer had not been found during screening, he explains, it would not have become apparent before the woman died from other causes. "This is a basic and critical factor, often ignored," says Gotzsche, "that many cancers are histologically malignant, but biologically benign.

The search for balance
Many women don't know about the negative side of mammography, and, it seems, they tend to overestimate its benefits. In a survey of more than 4,000 women designed to assess perception of the benefits of mammography, a full 68 percent believed screening prevents or reduces the risk of contracting breast cancer (screening has nothing to do with prevention); 62 percent believed screening reduces breast cancer mortality by half (although studies results vary, the 2006 Cochrane Review confirmed screening mammograms reduce the absolute risk of dying from breast cancer by a very modest 0.05 percent); and 75 percent believed 10 years of regular screening will prevent 10 or more breast cancer deaths per 1,000 women—approximately 10 times the most optimistic estimates.

One of the lone voices offering a balanced view on screening mammography (according to a 2004 study published in the British Medical Journal rating 27 cancer education websites) is the San Francisco-based breast cancer awareness and advocacy group, breast cancer Action (BCA). "The United States' public campaign to eradicate breast cancer has not focused on prevention, but largely on efforts that promote mammography screening," says BCA's executive director, Barbara Brenner, herself a two-time survivor of breast cancer. (See "Prevention Is Key" for ways to stop cancer before it starts.) Since its inception in 1991, BCA has raised concerns about mammography's effectiveness, and the dangers of misleading the public about the benefits of breast cancer "early detection" through screening mammography.

According to Brenner, mammography has several potentially harmful outcomes, especially for younger women, among them radiation risks (the earlier you begin screening mammography, the more radiation exposure you will experience) and a high incidence of false-negative (and false-positive) readings because younger women typically have denser breast tissue, which makes accurate mammogram readings more difficult. In sum, routine mammography screening, particularly for younger or pre-menopausal women, may cause more harm than good. (For more information on radiation risk, see "Why Fear Radiation?")

The evidence is in

A group of researchers led by Gotzsche, whose nonprofit organization is part of the highly-regarded Cochrane Collaboration, an international organization providing health-care analyses worldwide, reviewed all seven randomized mammography trials conducted prior to June 2005, involving half a million women. Most of the trials enrolled women ages 45 to 64, although one, the Canadian National Breast Screening Study included women ages 40 to 49.

In Gotzsche's review (updated several times, the latest in 2006), the four trials judged by the Cochrane researchers to have the poorest scientific quality yielded the greatest apparent benefit for screening mammography—a 29 percent reduction in the risk of breast cancer mortality after seven years and a 25 percent reduction after 13 years. In contrast, the two trials considered to have the highest scientific rigor, with adequate randomization, showed no significant reduction in breast cancer mortality.

One of the two highest quality mammography trials in Gotzsche's review, a Canadian study led by Cornelia J. Baines, MD, of the University of Toronto, Ontario, followed more than 50,000 women. The results after seven years in 1992 showed 36 percent more deaths from breast cancer among screened women than among unscreened women. Called the "breast cancer mortality paradox" at the ten-year follow-up, this percent then fell to 14 percent.

Although the numbers aren't statistically significant, Baines reports that similarly alarming trends were observed in other screening trials in women aged 40 to 49 years, including the Swedish Two-County Trial from 1985, as well as three other trials included in the Cochrane review. "Even if the results are not officially statistically significant, when the same results are observed multiple times, in multiple studies, the trend deserves attention," says Baines.

And as mentioned, Gotzsche's overall findings based on all trials, including those of poor quality, show an absolute risk reduction in breast cancer mortality of just 0.05 percent (for all women attending annual or semi-annual mammography screening). Screening also led to over-diagnosis and over-treatment, resulting in an absolute risk increase of 0.5 percent. "This means for every 2,000 women invited for screening throughout 10 years, one will have her life prolonged," explains Gotzsche. "In addition, 10 healthy women will be diagnosed as breast cancer patients and will be treated as such, unnecessarily."

What to do?
Simply put, the decision of whether to screen or not to screen is a tough one. Women have been sold on the idea that mammograms will save their lives. And yet the best studies don't seem to support this claim. Additionally, the blanket recommendation for screening mammography comes without solid information on the risk involved and the potential harm the procedure can cause.

Even mammography's most outspoken advocates acknowledge, however, that women should first focus on prevention and decide for themselves if the potential benefit of screening mammography outweighs the risks. Certainly, the controversy over screening should not deter a woman from getting a diagnostic mammogram if she has any troublesome symptoms or signs of breast cancer, such as a newly discovered lump, pain, or nipple discharge. (See "Assess Your Risk".)

And it's not as though you have many proven alternatives. Of the few options are available, none is a hands-down winner. (Look to "What Are the Alternatives?" for more information.) In the future, better, noninvasive tests may carry less risk than mammography. For now, says Lisa Schwartz, women face a difficult choice. "Our approach to breast cancer screening has fostered a climate where women are seen as irresponsible if they do not undergo screening. But screening has important trade-offs. We need to make sure that women understand this is a real decision that carries real consequences in both directions."

Vonalda Utterback
is a frequent contributor to Alternative Medicine magazine.

Prevention Is Key

"It's counterproductive to get stuck in the debate on screening mammograms," says Christine Horner, MD, surgeon, author, and a tireless crusader for women's breast health. "It's far more important for women to focus on prevention. Simply through good nutrition, supplements, and herbs, along with the right lifestyle choices, a woman can reduce her risk of breast cancer by more than 75 percent."

In Waking the Warrior Goddess: Dr. Christine Horner's Program to Protect Against and Fight breast cancer (Basic Health, 2005), Horner recommends eating the following nutrient-rich foods every day:
Fresh, organic fruits and vegetables. Concentrate on anti-cancer cruciferous veggies like broccoli, cauliflower, and cabbage, and high-antioxidant berries.
Organic whole grains. Grains are rich in cancer-fighting antioxidants, vitamins, trace minerals, fiber, and lignans.
Immune-enhancing maitake mushrooms.
Health promotingfats, such as omega-3 fatty acids from 2 to 3 tablespoons of ground flaxseeds daily. Avoid health-destroying saturated and trans fats.
Green tea, as a drink or a supplement. Women who drink six to 10 cups of green tea per day lower their risk of breast cancer.
Tumeric. The number one anti-cancer spice and a potent antioxidant and anti-inflammatory. Add one-quarter of a tablespoon at the end of cooking to almost any food.
Seaweed, such as wakame. Seaweed is high in iodine, which may be more effective at killing breast cancer cells than many common chemotherapeutic drugs, according to Horner.
Vitamins and minerals. Vitamin B12, folate, vitamin D, vitamin E, and selenium—help to crush cancer growth. Horner says as little as 200 micrograms (mcg) a day of selenium lowers your risk of breast cancer—and most other types of cancer—by 50 percent.
Coenzyme Q10. Consider this supplement if you are over the age of 35. Essential for the production of energy in cells, it may help contain or inhibit tumor growth.
Horner also urges women to nix these health busters:
Red meat. Woman who eat the most red meat have a higher risk of breast cancer.
Inactivity. Fat cells manufacture estrogen, notably after menopause. That's why obesity is thought to be responsible for 20 to 30 percent of all post-menopausal breast cancers. Just thirty minutes of aerobic activity three to five times a week can lower your risk of breast cancer by 30 to 50 percent, Horner says.
Cigarettes. Research shows that women who smoke or inhale passive smoke; have as much as a 60 percent increased risk of breast cancer.
Birth control pills or hormone replacement therapy (HRT). Long-term use may contribute to breast cancer.
Toxins. Avoid toxic overload and keep your home and body as toxin-free as possible; use only natural, nontoxic cleaning, bath, and beauty products.
All things that deplete melatonin, the sleep hormone. Melatonin arrests and deters breast cancer in many ways. Staying up past 10 p.m., alcohol, and electromagnetic fields from all electric appliances cause melatonin levels to drop.

Why Fear Radiation?

Mammograms employ low-dose X-rays to examine the breast. All X-rays use ionizing radiation, a known carcinogen with a cumulative effect on the body—in other words, the more you expose yourself, the more damage your body endures. In addition to annual radiation exposure from a screening mammogram, every false-positive mammogram reading often leads to a diagnostic mammogram and even more radiation exposure. Because radiation-induced mutations can actually cause breast cancer, radiation exposure over a lifetime increases cancer risk.

According to the US Department of Energy, a woman's radiation dose from a typical mammogram is 2.5 mSv (millisievert or effective dose). By comparison, the effective dose from a chest X-ray is considerably less at 0.1 mSv.

Assess Your Risk

You can estimate your risk for invasive breast cancer quantitatively with the website calculator provided by the National Institutes of Health (http://bcra.nci.nih.gov/brc/q1.htm). The calculator takes into account many of the known risk factors for breast cancer. Be sure to discuss your results with your healthcare practitioner. Although the model accurately predicts the risk for breast cancer for groups of women, its ability to discriminate between higher and lower risk for an individual woman is limited.

What Are the Alternatives?

Although a number of additional screening or diagnostic methods exist, most health professionals still consider the various options adjuncts to mammography, not replacements for it. This applies to breast self-exams (BSE) and clinical breast exam (CBE) —two very important screening tools that are, of course, non-harmful and non-invasive. (For more information on CBE and step-by-step instructions on how to effectively perform a BSE, go to www.cancer.org.) Here's a brief report on the top noninvasive methods used as adjuncts for early detection of breast cancer:

Thermography, or Digital Infrared Thermal Imaging (DITI)The promise. DITI is a painless, noninvasive procedure that uses a state-of-the-art, ultra-sensitive infrared camera and sophisticated computers to detect, analyze, and produce high-resolution diagnostic images of temperature variations within the breast (or any other part of your body). One of the main benefits of DITI is its sensitivity in detecting abnormalities, or changes in tissue, long before mammography or other screening methods could, which is why DITI advocates see it as a first-line screening method for breast cancer. While mammography relies primarily on finding the physical tumor, DITI detects the new blood vessels and chemical changes associated with a tumor's genesis and growth.

The pitfall.
DITI can't pinpoint the exact location of damaged or cancerous cells, so you still need additional procedures, such as mammography, to determine if an actual tumor is forming or has already formed, or to pinpoint the precise location of an existing abnormality. Another drawback to DITI: a lack of uniform regulation in DITI equipment and training for diagnostic technicians—and insurance plans rarely cover its use.

Ultrasound


The promise.
Ultrasound is a noninvasive, harmless, and painless imaging technique in which high-frequency sound waves bounce off breast tissue and convert them into an image of the breast's interior, called a sonogram. The procedure is helpful in distinguishing between solid masses and harmless cysts and may prevent the need for an invasive breast biopsy.

The pitfall.
Although ultrasound is a helpful diagnostic tool in separating benign lumps from cancerous tumors in dense breast tissue (i.e., younger women), it is most often used to evaluate lumps that already have been detected by CBE or mammogram. It's still considered complementary to mammograms and not a replacement for mammograms, even in dense breast tissue, because ultrasound cannot detect microcalcifications, small calcium deposits found within the breast tissue that may or may not indicate an underlying tumor.

Elasticity Imaging

The promise. An emerging, yet exciting new offshoot of ultrasound, elasticity imaging holds promise for even greater specificity in distinguishing benign from cancerous breast lesions. A 2006 study by Northeastern Ohio University's College of Medicine published in the Journal of the American Medical Association found that a real-time hand-held elasticity imaging device used in correlation with a routine ultrasound exam was 99 to 100 percent effective at identifying malignant versus benign lesions. Study investigators plan to expand their research in an international, multicenter trial this year.

The pitfall.
Similar to ultrasound, above. While elasticity imaging holds great promise to predict, with stunning accuracy, malignant versus benign lesions, and help reduce a major harm of screening mammography (over-diagnosis, resulting in unnecessary biopsies) no one is ready to say it's a replacement for mammography.

Find Out More

According to a survey published in the British Medical Journal of 27 websites containing information on mammography screening, the following websites garnered a top rating for balanced, unbiased information:
National breast cancer Coalition: www.stopbreastcancer.org
breast cancer Action: www.bcation.org

Tuesday, March 18, 2008

Gardasil Winners

By

Sally Fallon and Mary Enig PhD.
Weston A. Price Foundation

Vaccine pushers have pulled out all the stops to promote Gardasil, intensely marketing the new vaccine to the parents of young girls as young as age nine. The vaccine is said to protect against two strains of Human Papilloma Virus (HPV) which, according to the scare-mongers, cause about 70 percent of all cervical cancers.

Cervical cancer is rare, contributing to four deaths per 100,000 in the US, with less than 6 percent of these in women under 35 years of age. And causation by HPV has not been proven--in a controlled study of age-matched women, 67 percent of those with cervical cancer and 43 percent of those without were found to be HPV-positive and these cancers were observed on average only 20-25 years after infection. Apologists insist that it is perfectly safe to vaccinate millions of girls against the remote and unproven possibility of HPV-induced cervical cancer, citing clinical trials in which those receiving a placebo and those receiving the vaccine had a similar number of adverse events.

What trusting parents don't realize is that the placebo used in the trials was not a non-reactive saline solution, but contained reactive aluminum. This is the old "equivalent" placebo trick, which researchers use without the slightest twinge of conscience to "prove" the safety of poisonous additives like MSG and aspartame. The Gardasil vaccine contains 225 mcg of aluminum per jab.

Vaccine aluminum adjuvants can allow aluminum to enter the brain, as well as cause inflammation at the injection site leading to fatigue and chronic joint and muscle pain. The media have not seen fit to report on the shocking fact that around 60 (!) percent of those participating in the trials--both those who got the vaccine and those who got the "placebo"--suffered side effects such as headache, fever, nausea, dizziness, vomiting, and diarrhea. The side effects were more serious in the group receiving Gardasil, and included asthma, bronchospasm, arthritis and--most ironically--pelvic inflammatory disease.

The winners, of course, will not be the poor nine-year-olds subjected to vaccination, but the drug company Merck, which expects sales of at least two billion dollars by lobbying for their vaccine to be required for school admittance (www.ahrp.org/cms/content/view/263/28/)

The Worthless Flu Shot

" Basically they market a worthless, much hyped, $30 dollar injection of ethylene glycol (antifreeze), formaldehyde, aluminum and mercury..."



By Bob Mantz Jr. of Curezone.com


It is quite apparent that America has an addiction problem. Its not addiction to nicotine, alcohol, heroin or crack, though. Americans are addicted to the medical community. Statin drugs, blood pressure medications, Cylert, Vioxx, the list goes on and on. A search for the term 'drugs removed from the market' on Google returns hundreds of once FDA approved pills that were eventually taken away. Its a sad commentary on Americans and doctors in general when they hook an increasingly sedentary and obese population on drugs that they say are needed to control 'high' this and 'high' that. The middle-aged and senior community is actually our biggest drug abuser. They are hooked. You do not start on high blood pressure meds and cholesterol drugs and then get off them - you need them for life!

The biggest scam going this time of year every year is the flu shot. Larry Hanover's article, "Flu shots plentiful and popular', which appeared in the October 13th Trenton Times (on the front page for some reason), is peppered with words like 'grateful' and 'hype' to refer to the availability of this years vaccine while 'panic', 'awful' and 'heartbreaking' are utilized to paint the picture of last years vaccine shortage. Hanover points out that the Department of Health advises only high risk individuals should receive the shot before 10/24. High risk is defined as seniors over 65, children under 2, those in long term facilities, pregnant women and health care personnel. So demand is increased by utilizing scare tactics and marketing the fact that the vaccine may be in short supply. It feels like getting a Cabbage Patch Kid years ago or a Playstation on Christmas - pandemonium.

The National Institutes of Health researchers, basing their findings on more than 30 years of U.S. flu-shot data, announced that giving flu shots to the elderly has not saved any lives. "There is no evidence that any influenza vaccine thus far developed is effective in preventing or mitigating any attack of influenza. The producers of these vaccines know that they are worthless, but they go on selling them, anyway," according to Dr. J. Anthony Morris, formerly chief vaccine control officer at the FDA.

Tom Jefferson, MD, and colleagues at Cochrane Vaccines Field in Italy, conducted a review of the flu shots efficacy. Findings were reported in the September 22nd issue of The Lancet. According to the study, vaccines against influenza are only "modestly effective" in people in long-term care facilities and even less effective for elderly people still living in the community.

Dr. Marc Siegel, author of False Alarm: The Truth About the Epidemic of Fear, said, "We have set up a situation where a fear is created, and then we try to create the treatment for this fear. The public gets the idea that the flu is going to kill them and the vaccine will save them. Neither is true." "The vaccine doesn't work very well at all," said study author Dr. Tom Jefferson, an epidemiologist. "Vaccines are being used as an ideological weapon. What you see every year as the flu is caused by 200 or 300 different agents with a vaccine against two of them. That is simply nonsense."

This study followed the Center for Disease Control stating in 2004 that that year's flu vaccine had little or no effectiveness against influenza-like illnesses. http://www.cnn.com/2004/HEALTH/01/15/flu.vaccine/ Of the 1,000 people who got the vaccine before November 1, 149 went on to develop influenza-like illness (14.9 percent). Of the 402 people who did not get the vaccine, 68 got an influenza-like illness (16.9 percent), the study said. I think the words 'hype' and 'heartbreaking' should be used more appropriately to refer to the sale of a potentially dangerous snake-oil to the American population.

Basically they market a worthless, much hyped, $30 dollar injection of ethylene glycol (antifreeze), formaldehyde, aluminum and mercury. If you look at the ingredients of the inhaled vaccine, Flu-Mist, it gets worse. They throw in monosodium glutamate (MSG) for you to inhale.

Lone Simonsen, senior epidemiologist at the National Institute of Allergy and Infectious Diseases, said perhaps we should expand vaccination to schoolchildren. We're told to avoid tuna fish because it has small amounts of mercury, to wear a mask when around formaldehyde, not to get antifreeze near our mouths and that aluminum may be a cause of Alzheimer's, but we're going to advise parents to inject it directly into their children because they've stockpiled the worthless garbage and need to turn a profit. This is the same industry that kept promoting Vioxx to us.

Last year, due to the shortage, less folks then ever received the flu shot. And guess what? It is one of the slowest flu seasons ever.

Americans are taking in more and more potentially dangerous drugs because, in general, we are lazy. Caveat emptor - do the research and make an informed decision. The medical and pharmaceutical communities are not necessarily out for your good - they are out for their bottom line.

Bob Mantz, Jr. is a health researcher and interviewer as well as an editor for Curezone.com - the 2nd most visited alternative health site on the internet. He's interviewed doctors, herbalists & alternative health practictioners for web broadcast and CDs. His writings have appeared in numerous newspapers, newsletters and websites. Bob resides in Cranbury.